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Adolescents in a changing world

The case for urgent investment

© WHO / Faizza Tanggol

“Adolescents in a changing world – the case for urgent investment”

is the result of over two years of work by the PMNCH (Partnership for
Maternal, Newborn and Child Health), WHO, UNFPA, UNICEF, Victoria
Institute of Strategic Economic Studies (VISES) of Victoria University,
Melbourne, Australia and partners.
This major report argues that there are strong reasons why substantially increased investment
in programmes to promote adolescent well-being are both urgent and fully justified, including
the human rights of this substantial and increasing age group, the major epidemiological and
demographic transitions that are sweeping the world, and the fact that there is a substantial
repertoire of highly effective interventions and an increasing body of experience in how to
deliver them successfully. Such investments also make excellent economic sense, with a large
number of interventions across multiple domains of adolescent well-being yielding returns of at
least US$10 for every dollar invested. Furthermore, the costs of inaction are enormous.
The case for urgent investment in adolescents well-being
Today’s adolescents (10–19 years) face serious
challenges in a rapidly shifting world. These Figure 1. The definition and five domains of
range from the effect of population changes adolescent well-being
and age distribution and the increasing
importance of noncommunicable diseases, the
impact of climate change on mental health and
well-being, the learning crisis and the persistent
inequality, violence and neglect of human rights
experienced, especially by women.

The world needs to invest more in the well-being

of 1.3 billion adolescents across the world.
The cost of inaction is enormous. Over the
period 2024-50, the average cost of inaction
(benefits foregone) has been estimated at
US$110 trillion (USD 4.1 trillion per year).
This equates to 7.7% of the GDP of the
countries included in the models, which
cover about 80% of the world’s population.
This investment must be across sectors to cover
all aspects of adolescent well-being, it must
meet the context specific needs of adolescents
and have opportunities for adolescents to
contribute to design and development of
programmes for them.

The need for multi-sectoral policy and planning beyond the health sector
Transformative investment in three key platforms or systems is necessary: universal health coverage (UHC),
including Primary Health Care (PHC); enhanced schools that focus on learning, health, nutrition and
student well-being; and support systems based in local communities to ensure that they reach the most
vulnerable. These platforms are not only key for programme delivery but are essential to ensuring that all
adolescents are covered and that the complex linkages involved are fully realized.

Figure 2. Platforms, linkages and interventions

Key platforms

Universal health coverage system Enhanced schools Community development

Interventions

Sexual and reproductive health Retention at school Road accidents

Infectious diseases Learning quality Youth and parenting programs
Nutrition Social and emotional learning/school cluster Community programs
Non-communicable diseases Malnutrition (CM, IPV, FGM)
Mental health Child marriage Other violence
Substance abuse Adolescent pregnancy

Connectedness
Learning Agency and resilience

Domains Safe and supportive

Health
environment
Adolescent well-being as a driver of development
The economic and social returns from a wide range
Table 1. Selected examples of the returns on
of investments to address adolescent well-being are
investment from interventions to promote
high. Such investments will reduce inequalities and
help to protect the human rights of adolescents and
adolescent well-being
they have never been more timely, given the current
and future global demographic and epidemiological Return on
Intervention
transitions. There is now a substantial body of Investment of US$ 1
evidence that shows selected interventions for this
HPV US$ 20.2
age group can be highly effective. Finally, investing
in adolescents and their well-being strengthens the TB US$ 53.6
human capital of a country and hence the country’s
wealth-potential for future development and, for Myopia US$ 13.0
ending extreme poverty and creating more
inclusive societies. Scale-up of adolescent
US$ 9.6
health services
The modelling presented in the global report on
investing in adolescents’ well-being was conducted Education and training US$ 28.6
for the period 2024 to 2050. The key quantitative
measure used in developing the investment case is Preventing road injuries US$ 9.1
the benefit-cost ratio (BCR). This is the ratio of the Mental health US$ 23.6
value of benefits to the cost of the investments
necessary to achieve those benefits. For a wide School feeding
US$ 17.0
range of investments analysed here, the BCRs are programmes
10 or above, with much higher values in many cases.
An investment in which the benefits are 10 times the Reducing child marriage US$ 25.9
cost is a very strong one indeed. Examples of the
Programmes to reduce
estimated returns on investment (BCR) from selected US$10.1
female genital mutilation
interventions are shown in Table 1.

Six priority areas for investment in adolescent well-being now

With many affected countries already highly indebted, large-scale support from the international
community will be necessary for these investments to be undertaken on the required scale. At the same
time, locally tailored interventions taking account of specific needs and local knowledge and expertise
about effective programmes will be crucial.

This does not necessarily mean that

Within the need for an extensive programme of
investment to build the universal platforms, based
on BCR studies and other evidence assembled, six
priority areas have been identified:
ƒ malnutrition: hunger and undernutrition,
micronutrient deficiencies and overweight/obesity;
ƒ mental health: both prevention and treatment;
ƒ learning, skills and employment;
ƒ the position of women, including reductions in
child marriage and in unplanned pregnancies;
ƒ the prevention of violence and injury; and
ƒ the preparation of adolescents to cope with
emerging realities.
other areas may not give excellent
returns on investment, but the empirical
data to calculate their BCR is not yet there
in the literature.
Although a return of at least US$ 10 dollars
for every US$ 1 spent is excellent, the
cost of the full suite of investments
described in the global report are high.
Total costs for the period until 2035 are
estimated to approach US$ 2.8 trillion, or
an average of about US$ 230 billion per
annum over the 12-year period of 2024 to
2035 in present value terms. This amounts
to about 0.25% of the average projected
global gross domestic product (GDP) over
the period.
Large-scale and immediate investment to increase the capabilities and well-being of adolescents is now
of critical importance. This investment will empower young people to meet the challenges before them
and to thrive in the decades ahead.

What do young people want for their future? An agenda for action and investment
Adolescent and youth well-being is central to the development of a country’s human capital and deserves
considerable attention. Investing in adolescent well-being isn’t just one choice among many; it’s a moral
imperative of society at large.

The investment case spotlights the cost of inaction,

as well as the high returns on investment in
adolescent well-being. However, the question
remains – do we know what young people want for
their future and their lives? Do these demands
align with the priority areas that bring an increased
return on investment in adolescent well-being?
YES, THEY DO.
Under the PMNCH’s 1.8 Billion Young People for
Change Campaign, a campaign for and by young
people, the ‘What Young People Want’ Initiative
gathered 1.6 million responses from adolescents
and youth across 90 countries
In addition to health and optimum nutrition,
the survey revealed that over 40% of young people
considered learning, competence, education,
skills, and employability as crucial drivers of their
well-being. The responses were distilled into an
‘Agenda for Action for Adolescents’ (AAA), which
highlights seven key priorities for action. The AAA
co-developed with and co-owned by adolescents and
youth, defines a path forward for governments, in
partnership with stakeholders from all sectors, to
develop and implement policies and programmes
that deliver on these priorities. It advances the
adolescent agenda within the current Sustainable
Development Goals and sets the scene for the
post-2030 global development agenda.
The six priority areas for action recommended in
the Investment Case and demands of young people
serve as a powerful tool for advocacy and action.
For example, a broad package of health services
for adolescents is likely to give a return of US$9.6 for
every dollar invested, while investment of a dollar
in education and training is likely to give a return
of US$28.6 and mental health interventions are
estimated to provide a return of US$23.6 to a
dollar invested.
How can we build a more equitable,
sustainable, prosperous future?
1. Increase access to adolescent-friendly
health services including sexual and
reproductive health services, mental
well-being support and preventive care
2. Prioritize inclusive and quality education
and skill building that addresses the
diverse needs of adolescents
3. Ensure economic empowerment through
skills development, vocational training,
and job creation initiatives
4. Advance and advocate for gender equality
to ensure equal opportunities and rights
for adolescents in all their diversity
5. Mainstream meaningful adolescent and
youth engagement ensuring their active
participation in shaping/informing
policies, programmes, and initiatives
6. Leverage and strengthen community
support to provide a supportive
environment for adolescents
7. Follow up on existing commitments and
mobilize new commitments by highlighting
increased returns on investment

We have made several strides in securing the

well-being and rights of adolescents – yet a lot
remains to be done. We must come together and
commit for increased prioritization, targeted action,
robust accountability, better commitments and
fewer barriers/hurdles to adolescent well-being.

© WHO / /Fid Thompson